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(136) A 26-year-old Type I diabetic class B reports decreased fetal movement She is at 37 weeks estimated gestational age and has had poor glycemic control throughout pregnancy The manual estimated fetal weight is 2000 grams and the fundal height is somewhat less than the estimated gestational age What type of screening should be performed to assess fetal well-being and placental sufficiency (a) Non-stress test followed by abdominal ultrasound to assess for presentation, amniotic fluid, and placental location (b) Biophysical profile (c) Amniocentesis with analysis for fetal lung maturity (d) Cordocentesis with analysis of pH, lactic acid, and immunoglobulins (137) An obese 38-year-old with chronic hypertension and Type II diabetes is found to be 6 weeks pregnant Her medications include: an ACE inhibitor, beta-blocker, thiazide diuretic, metformin, folic acid, and a multivitamin Which of the following medications (choose all that apply) are safe in pregnancy (a) Insulin (b) ACE inhibitors (c) Glyburide (d) Thiazide (138) An Rh( ) mother has just undergone a normal spontaneous vaginal delivery with significant postpartum hemorrhage attributed to atony What test would assist in determining how much RhoGam should be administered postpartum (a) Quantitative titer analysis of maternal circulating antibodies (b) Flow cytometry to determine which isoforms the mother has developed
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(c) Kleihauer-Betke serum stain (d) Indirect Coombs test (139) A woman with gestational diabetes class A1 and poor glycemic control requests a repeat cesarean delivery Fetal lung maturity (FLM) at 37 weeks shows a lecithin/ sphingomyelin ratio of 22/ and phosphatdylglycerol negative Following delivery, the infant develops respiratory distress syndrome (RDS) What about the patient s history would suggest that the infant was at risk for RDS (a) Two or more types of fetal lung maturity tests should be used when determining the risk of RDS (b) Elective cesarean delivery should only take place after 39 weeks (c) The amniocentesis was likely contaminated with blood, resulting in a false L/S ratio (d) Surfactant function and production is adversely affected by increased fetal insulin and maternal diabetes (140) A 36-year-old female presents with a single, firm, well-delineated, round, nontender nodule in her left upper breast When her gynecologist palpates, it is very mobile with respect to its surrounding tissue What is the most likely diagnosis of this mass (a) Ductal carcinoma in situ (b) Papillary cystadenocarcinoma (c) Breast cyst (d) Adenocarcinoma Answer: d Answer: d
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(141) Tubal patency or pelvic factor in evaluation of infertility is best accomplished by: (a) Hysterosalpingogram (HSG) (b) Hysteroscopy (c) Pelvic magnetic resonance imaging (MRI) (d) Transvaginal ultrasound (e) Pelvic CT scan (142) You are seeing your 35-year-old patient, who has sought your help several times prior for vague but persistent gynecologic concerns She currently complains of pelvic discomfort You have evaluated her in the past for the same concern and found no gynecologic or gastrointestinal etiology As you continue to ask her more questions, she begins to cry and reveals that she was sexually abused as a child Which of the following statements aboutsexual abuse is most statistically accurate (a) Her abuser was someone she did not know well (b) Her abuser was a member of her family (c) Approximately 5% of women have experienced childhood sexual abuse (d) The abuse took place at a daycare center (e) She was abused between the ages of 2 and 10 (143) Through chromosome analysis, you find that your patient has a sex genotype of XO What is the proper therapeutic regimen for this patient (a) Androgens and cortisol (b) Cortisol and human growth hormone
Answer: a
Answer: b
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(c) Small doses of estrogen in early childhood (d) Progesterone, estrogen, and cortisol (e) Androgens, human growth hormones, small doses of estrogen, and later progesterone (144) In evaluating an infertile couple, the postcoital test is performed to assess which of the following (a) Interaction of sperm with cervical mucus prior to ovulation (b) Interaction of sperm with cervical mucus anytime during the cycle (c) Interaction of sperm with cervical mucus during ovulation (d) Interaction of sperm with cervical in midluteal phase (145) All of the following may be direct causes of female infertility except: (a) previous uncomplicated abortion (b) endometriosis (c) pelvic inflammatory disease (PID) (d) hyperprolactinemia (e) polycystic ovarian syndrome (PCOS) (146) What is the most common presenting fracture in osteoporosis (a) Vertebral compression fracture (b) Wrist fracture (c) Tibial fracture (d) Femoral head fracture (e) Femoral neck fracture Answer: a Answer: a Answer: a
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